Search Results (75)

Background: Although the main target of SARS-CoV-2 is the respiratory system, in some patients, it may affect multiple organ systems, leading to multi-organ failure. Acute kidney injury (AKI) remains one of the most frequent and clinically significant complications of severe COVID-19, with clinical importance extending beyond the acute phase due to its association with long-term renal outcomes and persistent morbidity. The incidence of AKI is particularly high among patients admitted to the intensive care unit (ICU), where its development has been consistently associated with prolonged hospitalization and increased mortality. The primary aim of this study was to determine the incidence of COVID-19-associated AKI, identify factors related to its development and severity, and evaluate mortality as a clinical outcome. Methods: Data from 238 COVID-19 patients monitored in the Intensive Care Unit of Ankara University Ibni Sina Hospital (ISH-ICU) between 1 January 2021 and 1 January 2022 were retrospectively reviewed. Patients were divided into two groups according to the presence of AKI. Those with AKI were staged according to KDIGO criteria (stages 1–2–3). Demographic characteristics, comorbidities, disease severity scores, laboratory parameters, and mortality outcomes were analyzed and compared between groups. Results: AKI was identified in 54.6% of patients. Of the patients with AKI, 32 (13.4%) had stage 1, 25 (10.5%) had stage 2, and 73 (30.7%) had stage 3 AKI. Thirteen patients (5.5%) had already developed AKI at ICU admission. AKI developed at a median of 11 days after symptom onset and 3 days after ICU admission. Advanced age, hypertension, cardiovascular disease, and chronic kidney disease were more frequent in patients with AKI (p < 0.001). Higher Charlson Comorbidity Index (CCI) and Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) scores were observed in patients with stage 3 AKI. Lymphopenia and elevated levels of D-dimer, ferritin, IL-6, CRP, and procalcitonin were significantly higher in patients with stage 3 AKI than in patients with other AKI stages and the non-AKI group. Mortality rates were higher in patients with AKI and increased with advancing AKI stage (p < 0.001). ICU length of stay was significantly longer in the AKI group (p < 0.001). Conclusions: AKI is a common complication among critically ill patients with COVID-19 and is associated with prolonged ICU stay and higher mortality rates, particularly in advanced stages. Early identification of clinical and laboratory factors associated with AKI may support timely risk stratification and targeted management in this high-risk population. Full article

Serum creatinine (sCr) and urine output (UO) have long been considered the cornerstones of acute kidney injury (AKI) severity criteria. Many articles were previously published discussing the prognostic relevance of fulfilling either one or both AKI criteria. However, sCr and UO must not be considered independent variables because they are physiologically linked despite having distinct chronologies as AKI markers. An increase in sCr is a late manifestation of decreased renal function and body creatinine accumulation and not an on-time surrogate for a decreasing glomerular filtration rate. On the other hand, oliguria is not a single entity, and its interpretation relies on urine’s biochemical composition as well as its threshold pathological output value, which is somewhat controversial. In the present article, the current practice of evaluating sCr and UO separately is questioned and the idea that they can eventually be considered different expressions of the same variable of interest (the urine creatinine excretion) is highlighted. Full article

Background: Acute kidney injury (AKI) remains one of the most common perioperative complications, carrying substantial mortality and healthcare burden. Traditional diagnostic criteria relying on serum creatinine and urine output are limited by delayed detection and inability to characterize the underlying injury phenotype. This scoping review examined the current state of novel AKI biomarker research in perioperative care, evaluated their clinical implementation, and identified knowledge gaps. Methods: A systematical search was performed for studies investigating novel AKI biomarkers in surgical settings. Biomarkers were categorized as functional, stress, or damage markers. Data extraction focused on diagnostic performance, clinical outcomes, regulatory approval status, and implementation barriers. A narrative synthesis was organized by biomarker category and thematic areas. Results: Several biomarkers demonstrated superior early diagnostic performance compared to traditional ones, including PENK or CCL-14, showing promising accuracy for AKI detection and outcome prediction. TIMP-2*IGFBP-7 and NGAL achieved regulatory approval, and biomarker-guided KDIGO care bundles significantly reduced AKI incidence in surgical populations. However, substantial heterogeneity exists in assays, cutoff values, and clinical validation across different clinical settings. Conclusions: Novel AKI biomarkers offer a promise for early detection and risk stratification in perioperative care, yet widespread clinical adoption requires addressing standardization challenges, establishing cost-effectiveness, and validating implementation strategies. Full article

Background/Objectives: CKD affects over 10% of adults and is often silent, delaying diagnosis. Opportunistic primary care screening supported by clinical decision support systems (CDSSs) may improve detection with minimal burden. We evaluated the feasibility, diagnostic yield, clinical actions, and reagent costs of a CDSS-enabled, albuminuria-first program using eGFR. Methods: This one-year cross-sectional intervention screened all patients receiving routine laboratory tests at a primary care center using a CDSS integrating prior labs, medical records, and guideline rules. Eligibility required patients age 60–85 (Group 1) or 18–59 with hypertension, diabetes, or cardiovascular disease (Group 2). Eligible patients received urine albumin and eGFR testing with standard phlebotomy; abnormal findings triggered confirmatory tests. Outcomes were diagnostic yield, KDIGO risk stratification, referral patterns, and reagent costs. The CDSS surfaced prompts and pre-populated orders in the laboratory interface. Results: Of 7722 targets, 1892 (24.5%) were flagged (34.2% of Group 2, 7.9% of Group 1), and 1774 (93.8%) completed screening. We identified 104 new CKD cases (5.9%): 75% KDIGO moderate risk, 19% high, and 6% very high. Twenty patients (1.1%) met criteria for nephrology referral. Guideline-directed therapy was started or optimized in 90%, and 62.5% received a new CKD diagnosis code. Reagent costs averaged EUR 0.51 per person screened and EUR 11.14 per CKD case detected. Most cases were early-stage and manageable in primary care. Conclusions: CDSS-enabled opportunistic screening in primary care is feasible, acceptable, and low-cost. It identifies previously unrecognized CKD at modest expense, enabling early interventions that may slow progression and reduce cardiovascular events. Scaling with follow-up should assess long-term outcomes. Full article

Vancomycin remains a cornerstone for severe Gram-positive infections in the ICU, yet creatinine elevation—a sensitive marker of early renal stress—occurs frequently and complicates therapy. We developed a machine learning model to predict vancomycin-associated creatinine elevation using routinely available clinical data, enabling preemptive risk stratification. In this retrospective MIMIC-IV cohort study ($n=10,288$ ICU adults aged 18–80 receiving vancomycin), the primary outcome was creatinine elevation per KDIGO criteria (≥0.3 mg/dL within 48 h or ≥50% within 7 d). A two-stage feature selection (SelectKBest + Random Forest) identified 15 predictors from 30 candidates. Six algorithms were compared via 5-fold cross-validation. CatBoost was selected for final modeling; interpretability was assessed using SHAP values and Accumulated Local Effects (ALE) plots. Creatinine elevation occurred in 2903 patients (28.2%). CatBoost achieved AUROC 0.818 (95% CI: 0.801–0.834), sensitivity 0.800, specificity 0.681, and NPV 0.900. Top predictors were serum phosphate, total bilirubin, magnesium, Charlson Comorbidity Index, and APSIII score. SHAP analysis confirmed hyperphosphatemia as the strongest driver; ALE plots revealed non-linear, clinically plausible thresholds (e.g., phosphate >4.5 mg/dL sharply increased risk). This interpretable model accurately predicts vancomycin-associated creatinine elevation using standard ICU monitoring data. With high negative predictive value, it supports early exclusion of low-risk patients and targeted interventions (e.g., intensified TDM, nephrotoxin avoidance) in high-risk cases—facilitating precision antimicrobial stewardship in critical care. Full article

Background/Objectives: Coronavirus disease 2019 (COVID-19) has emerged as a multisystem disorder, with acute kidney injury (AKI) representing a frequent and severe complication associated with poor outcomes. This study assessed the incidence, risk factors, and outcomes of AKI in patients with severe COVID-19 across three pandemic waves. Methods: We retrospectively analyzed 561 patients with severe COVID-19 admitted to a tertiary hospital between March 2020 and December 2021. AKI was defined and staged according to KDIGO 2012 criteria. Demographic, clinical, laboratory, and imaging data were evaluated using univariate and multivariable logistic regression and ROC curve analyses to identify predictors of AKI. Results: AKI occurred in 71 patients (12.65%), most frequently during the third wave (40.9%). Stage 1 accounted for 62% of cases, while 23.9% progressed to stage 3 and 10% required dialysis. Compared with patients without AKI, those with AKI had longer hospital stays (15 vs. 11 days), more intense inflammatory responses (CRP 91.7 vs. 63.3 mg/L, p = 0.002), and higher mortality (35.2% vs. 10.2%, p < 0.001). Multivariable analysis identified elevated serum myoglobin (OR = 1.010, p = 0.001), prolonged corticosteroid therapy (OR = 1.096, p = 0.035), and lower hemoglobin (OR = 0.375, p < 0.001) as independent factors of AKI. Conclusions: AKI in severe COVID-19 is multifactorial, reflecting the interplay of systemic inflammation, cytolysis, coagulopathy, and renal microvascular dysfunction. The risk increases with higher myoglobin levels, longer corticosteroid exposure, and lower hemoglobin, highlighting the need for early identification and preventive strategies in high-risk patients. Full article

Acute Kidney Injury (AKI) following endovascular aortic repair (EVAR) is often diagnosed too late using conventional markers, limiting opportunities for timely intervention in this high-risk population. We investigated whether a mechanism-based biomarker panel could provide improved early AKI detection in EVAR patients. This prospective, single-center study enrolled 68 consecutive EVAR patients between April 2022 and June 2024. AKI was diagnosed using KDIGO 2012 criteria. Seven novel biomarkers, including Proenkephalin A 119-159 (penKid), Semaphorin-3A (SEMA-3A), Retinol Binding Protein-4 (RBP-4), Kidney Injury Molecule-1 (KIM-1), Netrin-1, Tissue Inhibitor of Metalloproteinases-2, and Insulin-Like Growth Factor Binding Protein-7, were measured at baseline, immediate postoperative, 24 h, and 48 h time points, and selected based on distinct nephron locations and release mechanisms. AKI occurred in 18 (26.5%) patients. Top-performing individual biomarkers included serum SEMA-3A (AUC 0.88), serum RBP-4 (AUC 0.81), and penKid (AUC 0.76). A three-biomarker panel combining serum penKid, serum SEMA-3A, and urinary KIM-1 achieved robust discriminatory performance (AUC 0.89, 95% CI 0.77–1.00), superior to individual biomarkers. An alternative panel with serum RBP-4 demonstrated comparable performance (AUC 0.81, 95% CI 0.65–0.99). Multi-biomarker panels combining functional, stress, and injury markers demonstrate promising performance for early AKI detection in EVAR patients. External validation in independent, multi-center cohorts is required before clinical implementation. Full article

Background: High-dose cisplatin (≥200 mg/m² cumulative) remains the standard of care in concurrent chemoradiotherapy (CRT) for locally advanced head and neck squamous cell carcinoma (LA-HNSCC). However, its use is frequently limited by nephrotoxicity, including acute kidney disease (AKD). This recently described clinical renal syndrome encompasses functional alterations of the kidney lasting fewer than 3 months post-exposure. Although hydration protocols and antiemetic strategies are routinely applied to avoid reduction in oral liquid intake and to prevent dehydration that could worsen renal function, AKD continues to pose a threat to reach the therapeutic dose, to treatment completion, and long-term outcomes. Recent evidence supports the nephroprotective role of intravenous (IV) magnesium in mitigating cisplatin-induced tubular injury, yet prospective data on its impact in real-world LA-HNSCC settings remain limited. We aimed to prospectively investigate the incidence and characteristics of renal impairment, particularly AKD, in a real-world cohort of LA-HNSCC patients treated with high-dose cisplatin and standardized supportive therapy, including intravenous magnesium. Methods: We conducted a prospective observational study including 207 patients with LA- HNSCC undergoing high-dose cisplatin-based CRT (≥200 mg/m² cumulative dose), within a standardized supportive care protocol incorporating IV magnesium. Renal function was assessed over three cycles via serum creatinine and estimated glomerular filtration rate (eGFR). AKD was defined and staged according to KDIGO criteria. Clinical and biochemical predictors of AKD were explored. Results: AKD occurred in 5.3% of patients (11/207; 95% CI 2.7–9.3), with eight events between C1→C2, 3 between C2→C3, and 0 thereafter; recovery at the next cycle was 9.1% (1/11). Among them, 57.1% were classified as stage 1. A baseline eGFR < 90 mL/min/1.73 m² was associated with a higher AKD incidence (13.3% vs. 5.4%). Body mass index (BMI) was significantly associated with AKD in univariate analysis (p = 0.02), whereas no independent predictor emerged in multivariate analysis. Use of renin–angiotensin–aldosterone system (RAAS) inhibitors was more frequent among patients who developed AKD (p = 0.04). Renal function declined more steeply in AKD patients, with a median eGFR slope of −0.3917 mL/min/1.73 m²/day vs. −0.0483 mL/min/1.73 m²/day in those without AKD (p = 0.0005), irrespective of CKD stage. Conclusions: In a real-world cohort receiving high-dose cisplatin with structured nephroprotection including IV magnesium, AKD developed in approximately 10% of patients. Lower baseline eGFR, elevated BMI, and RAAS inhibitor use emerged as potential risk factors. These findings reinforce the importance of proactive renal monitoring and suggest a role for magnesium supplementation as an accessible strategy to enhance renal safety in curative-intent CRT. Full article

Background/Objectives: Acute kidney injury (AKI) is a common and severe complication in patients with acute myocardial infarction (AMI). Very elderly patients are at a heightened risk of developing AKI. Fibrinogen and albumin are well-known biomarkers of inflammation and nutrition, which are highly related to AKI. We aim to explore the predictive value of the fibrinogen-to-albumin ratio (FAR) for AKI in very elderly patients with AMI. Methods: A retrospective cohort of AMI patients ≥ 75 years old hospitalized at the First Affiliated Hospital of Xi’an Jiaotong University between January 2018 and December 2022 was established. Clinical data and medication information were collected through the biospecimen information resource center at the hospital. Univariate and multivariable logistic regression models were used to analyze the association between FAR and the risk of AKI in patients with AMI. FAR was calculated as the ratio of fibrinogen (FIB) to serum albumin (ALB) level (FAR = FIB/ALB). The primary outcome is acute kidney injury, which was diagnosed based on KDIGO 2012 criteria. Results: Among 1236 patients enrolled, 66.8% of them were male, the median age was 80.00 years (77.00–83.00), and acute kidney injury occurred in 18.8% (n = 232) of the cohort. Comparative analysis revealed significant disparities in clinical characteristics between patients with or without AKI. Patients with AKI exhibited a markedly higher prevalence of arrhythmia (51.9% vs. 28.1%, p < 0.001) and lower average systolic blood pressure (115.77 ± 25.96 vs. 122.64 ± 22.65 mmHg, p = 0.013). In addition, after adjusting for age, sex, history of hypertension, left ventricular ejection fraction (LVEF), and other factors, FAR remained an independent risk factor for acute kidney injury (OR = 1.47, 95%CI: 1.36–1.58). ROC analysis shows that FAR predicted stage 2–3 AKI with superior accuracy (AUC 0.94, NPV 98.6%) versus any AKI (AUC 0.79, NPV 93.0%), enabling risk-stratified management. Conclusions: FAR serves as both a high-sensitivity screening tool for any AKI and a high-specificity sentinel for severe AKI, with NPV-driven thresholds guiding resource allocation in the fragile elderly. Full article

Background: Intravenous vancomycin remains a key agent in the treatment of complex orthopedic infections, particularly those involving methicillin-resistant Staphylococcus aureus (MRSA). However, its use is associated with significant risks, most notably nephrotoxicity. Despite guideline recommendations, standardized dosing and monitoring protocols are often absent in orthopedic settings, leading to inconsistent therapeutic drug exposure and preventable adverse events. This study evaluated the clinical impact of implementing a structured standard operating procedure (SOP) for intravenous vancomycin therapy in orthopedic inpatients. Methods: We conducted a single-center, pre-post cohort study at a university orthopedic department. The intervention consisted of a standard operating procedure (SOP) for intravenous vancomycin therapy, which mandated weight-based loading doses, renal function-adjusted maintenance dosing, trough level monitoring, and defined dose adjustments. Patients treated before SOP implementation (n = 58) formed the control group; those treated under the SOP (n = 56) were prospectively included. The primary outcome was the incidence of vancomycin-associated acute kidney injury (VA-AKI) defined by KDIGO Stage 1 criteria. Secondary outcomes included therapeutic trough level attainment and infusion-related or ototoxic adverse events. Results: All patients in the post-SOP group received a loading dose (100% vs. 31% pre-SOP, p < 0.001). The range of measured vancomycin trough levels narrowed substantially after SOP implementation (7.1–36.2 mg/L vs. 4.0–80.0 mg/L). The proportion of patients reaching therapeutic trough levels increased, although this was not statistically significant. Most notably, VA-AKI occurred in 17.2% of patients in the control group, but in none of the patients after SOP implementation (0%, p = 0.0013). No cases of ototoxicity were observed in either group. Infusion-related reactions decreased after the implementation of the SOP, though not significantly. Conclusions: The introduction of a structured vancomycin protocol significantly reduced adverse drug events and improved dosing control in orthopedic inpatients. Incorporating such protocols into routine practice represents a feasible and effective strategy to strengthen antibiotic stewardship and clinical quality in surgical disciplines. Full article

Background and Aims: Sepsis-associated acute kidney injury (S-AKI) is common and is associated with poor outcomes. This prospective observational study aimed to assess the predictive value of four novel biomarkers—syndecan-1 (SDC1), neutrophil gelatinase-associated lipocalin (NGAL), proenkephalin (PENK), and presepsin (PSPN)—for renal outcomes and mortality in septic ICU patients. Methods: Serum biomarker levels were measured in serum samples collected at the time of sepsis diagnosis on the basis of the Sepsis-3 criteria. Acute kidney injury (AKI) was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, and patients were grouped by the presence of AKI, renal replacement therapy requirement (RRT), and intensive care unit (ICU) survival. Demographic, clinical, laboratory, and severity score data were compared between groups to evaluate the predictive performance of biomarkers and clinical parameters. Results: Of the 140 septic patients included, 55.0% developed AKI, 17.2% required RRT, and the ICU mortality rate was 50.0%. SDC1 was independently associated with both AKI (OR: 1.201; p = 0.024) and RRT initiation (OR: 1.260; p = 0.004). It also demonstrated the highest predictive performance for RRT (AUC: 0.715; p = 0.001) and a significant AUC for AKI evaluation (AUC: 0.659; p = 0.002). NGAL levels were significantly elevated in patients with AKI and higher SOFA scores but were not independently predictive. PENK and PSPN were not significantly associated with any renal outcome or mortality. The combined SOFA–SDC1 model improved discrimination for both AKI (AUC: 0.770) and RRT (AUC: 0.737), surpassing individual predictors. Conclusions: SDC1 emerged as the most reliable biomarker for assessing AKI and predicting the need for RRT, highlighting its potential role in early renal risk stratification among critically ill patients. Full article

Background/Objectives: Acetazolamide is widely used for acute mountain sickness (AMS) prophylaxis. Whilst generally safe, acute kidney injury (AKI) is a rare but serious adverse event. We present a case of anuric AKI following minimal exposure to acetazolamide, contributing to the limited literature on its nephrotoxicity at prophylactic doses. Methods: A 54-year-old previously healthy male ingested 250 mg/day of oral acetazolamide for two days. He developed acute anuria and lumbar pain. Diagnostic evaluation included laboratory tests, imaging, microbiological cultures, autoimmune panels, and diuretic response. No signs of infection, urinary tract obstruction, or systemic disease were found. Results: The patient met KDIGO 2012 criteria for stage 3 AKI, with peak serum creatinine of 10.6 mg/dL and metabolic acidosis. Imaging confirmed non-obstructive nephrolithiasis. Conservative treatment failed; intermittent hemodialysis was initiated. Renal function recovered rapidly, with the normalization of serum creatinine and urinary output by day 4. Conclusions: This case represents the lowest cumulative dose of acetazolamide reported to cause stage 3 AKI. The findings support a pathophysiological mechanism involving sulfonamide-induced crystalluria and intratubular obstruction. Physicians should consider acetazolamide in the differential diagnosis of AKI, even with short-term prophylactic use. Full article

Background: While postoperative acute kidney injury (AKI) in patients with hip fracture has been investigated, the relationship between fracture morphology and the incidence of preoperative AKI remains unclear. This study aimed to investigate the association between fracture morphology and the incidence of preoperative AKI, as well as its impact on in-hospital mortality and length of hospital stay. Methods: A retrospective analysis was conducted on 462 patients with intertrochanteric fractures treated at a single university hospital between January 2018 and December 2023. The fractures were categorized based on radiographic morphology into two groups: simple fractures and comminuted fractures. Preoperative AKI was diagnosed using KDIGO criteria based on serum creatinine levels measured at the time of emergency department admission. Demographic characteristics and comorbidities were collected. Clinical outcomes included time to surgery, length of hospital stay, and in-hospital mortality. Multivariable logistic regression was used to identify independent risk factors for preoperative AKI. Results: Among 462 patients, 66 (14.3%) developed preoperative AKI. The incidence of AKI was significantly higher in the comminuted fracture group than in the simple fracture group (17.5% vs. 10.2%, p = 0.037). Multivariable analysis identified comminuted fracture morphology as an independent risk factor for preoperative AKI (OR 2.44, 95% CI 1.19–5.00, p = 0.015). Preoperative AKI was also significantly associated with increased in-hospital mortality (OR 4.56, CI 1.40–14.81, p = 0.018). Conclusions: Comminuted intertrochanteric fracture is significantly associated with an increased risk of preoperative AKI. Preoperative AKI is linked to worse clinical outcomes, including higher in-hospital mortality. These findings emphasize the importance of close monitoring of renal function and proper management of AKI in comminuted fracture group. Full article

Background: Immune checkpoint inhibitors (ICIs) have significantly modified the management of metastatic cancers; however, their nephrotoxic potential remains underappreciated. While acute kidney injury (AKI) is a known immune-related adverse event, the subacute spectrum of kidney injury—termed acute kidney disease (AKD)—has not been adequately explored in this setting. Methods: We conducted a retrospective cohort study in 226 adult patients with metastatic solid tumors who received ICIs between 2017 and 2023 at a single tertiary care center. AKD was defined according to the 2024 “Kidney Disease: Improving Global Outcomes” (KDIGO) criteria. Multivariable logistic regression was used to identify predictors of AKD. Results: AKD occurred in 46 patients (20.4%) within 90 days of ICI initiation, with 16 (7.1%) experiencing persistent dysfunction beyond 30 days. Independent predictors of AKD included higher body surface area (OR 8.17, p = 0.03) and baseline use of nonsteroidal anti-inflammatory drugs (OR 29.74, p = 0.014). Baseline antibiotics showed a trend toward association (p = 0.054). Concurrent chemotherapy was associated with a trend toward protection. The predictive model showed good discrimination (AUC 0.778). No significant differences in other grade ≥2 immune-related adverse events were observed between the AKD and non-AKD groups. Conclusions: AKD is a frequent and underrecognized renal complication in patients receiving ICIs, with implications for both renal and oncological outcomes. Identifying high-risk patients and integrating longitudinal renal monitoring into immunotherapy care pathways may improve safety and treatment continuity. Full article

Background: Numerous studies have explored the potential of the biomarker copeptin (CPP) in diagnosing and assessing the severity of chronic kidney disease (CKD). Despite these efforts, findings have been inconsistent. Consequently, this study aimed to examine the association between CPP and CKD, specifically evaluating its diagnostic value and correlation with CKD severity as classified by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Methods: A systematic search of PubMed, EMBASE, and Scopus was conducted using a predefined search string to identify relevant studies. Eligible studies included those involving CKD patients classified by glomerular filtration rate (GFR) according to the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines or by the estimated GFR (eGFR) calculated using the MDRD formula, provided they met predefined inclusion criteria. Study quality was assessed using the Newcastle–Ottawa Scale (NOS). The primary outcome measured was the mean difference (MD) in serum CPP levels across the various stages of CKD. Results: A total of seven studies, comprising 2769 participants, met the inclusion criteria and were incorporated into our systematic review and meta-analysis. Notable differences in CPP levels were identified across various comparisons. Specifically, CPP levels were significantly elevated in CKD patients compared to healthy controls, with a mean difference (MD) of 12.975 (95% CI 6.572, 19.379). Additional significant MDs were observed in comparisons including controls versus CKD stages 1–2/2 (−1.600 [95% CI −3.179, −0.020]), controls versus CKD stage 3 (−9.598 [95% CI −12.959,−6.237]), controls versus CKD stages 4–5 (−28.776 [95% CI −42.925, −14.628]), and CKD stages 1–2 versus stages 4–5 (−30.475 [95% CI −46.790, −14.160]). Conclusions: Comparison between the CKD patients and healthy controls revealed significantly elevated CPP levels, suggesting a possible role in renal pathology. Furthermore, the distinct differences in CPP concentrations across various CKD stages highlight its potential as a biomarker for assessing disease severity and progression. Full article